R23m suit against Netcare Greenacres and former PE paediatrician

Eastern Cape High Court (Port Elizabeth) Acting Judge Nicholas Mullins heard that a cascade of events that left a new-born baby with severe brain injuries was preventable by the administration of a medical product easily available to a paediatrician, reports The Herald.

Chris Mouton SC, representing the parents of the child, now 10, said the first 48 hours after the girl was born in November 2008 were crucial and will form the basis of the R23m lawsuit against Netcare Greenacres Hospital and specialist paediatrician Dr Charmaine van Heerden, formerly of PE and now practising in Walvis Bay, Namibia.

According to the report, Mouton told the court a reasonable paediatrician would have administered a surfactant timeously which, he claimed, added to the negligence. A fluid secreted by the alveoli in the lungs is a surfactant and contributes to the elasticity of the lungs and air passages. The girl born at 32 weeks was about eight weeks premature and, according to Mouton, was in a good condition but was shortly after birth diagnosed with hyaline membrane disease (HMD) by van Heerden.

HMD almost always occurs in premature babies when there is not enough surfactant produced but it is easily treated pre-birth or shortly thereafter. ‘The primary focus (of this case) is the failure to administer surfactant timeously,’ Mouton said.

The report says part of the claim is that van Heerden allegedly did not order a further chest X-ray after diagnosing the baby with HMD or an arterial blood gas test in time to determine the oxygen level in the child’s blood. After diagnosing the baby with HMD, van Heerden allegedly ordered that she be treated with a continuous positive airway pressure intervention, which Mouton claimed could be deadly for a baby.

“Evidence will be (presented that) a pneumothorax (or collapsed lung), which is air leaking from the lungs and collecting between the lung and chest wall, is the most common concern with a continuous positive airway pressure intervention. “(Van Heerden and hospital staff) didn’t seem to consider a [collapsed lung] was developing. (They) failed to recognise that the infant showed all the relevant signs that a pneumothorax was developing. Had surfactant been administered we would not have been here today,” Mouton said.

Mouton said the main allegation that the child’s condition deteriorated after 4.30pm on 21 November 2008 after van Heerden had left the hospital with nonspecific instructions to nurses and the failure of hospital employees to perform an arterial blood gas test, showed causal negligence.

Neonatology head at Tygerberg Children’s Hospital, in Cape Town, Professor Johan Smith, said in the report it was not clear in the documentation he had been given what type of continuous positive airway pressure intervention had been used on the baby but that between 7.10am and 2pm the pressure had been increased.

“Progress showing the condition worsening (could be because) increased pressure can lower oxygen levels [in the blood].”

Smith said that, according to the hospital records and nurses’ charts, there was an initial improvement in the baby’s condition but it was clear the baby was showing symptoms of respiratory distress syndrome. “The infant was in constant respiratory distress,” he said.

The report says Smith asked why van Heerden had told staff in the neonatal ICU section at Greenacres Hospital to monitor the baby every six hours. "I do not agree with that. It is the ICU, they should monitor regularly, at least hourly,” Smith said.

Smith told the court it was his opin­ion that mis­man­age­ment of the baby’s treat­ment, in­clud­ing ob­scure ven­ti­la­tor set­tings and the de­lay in ad­min­is­ter­ing cru­cial medication by Van Heer­den, led to the child suf­fer­ing se­vere brain and lung in­juries.

Smith said that had Van Heer­den given the girl Sur­fac­tant prior to her col­laps­ing at 3am on Novem­ber 22 2008, her near-death in­juries could have been avoided.

“I must em­pha­sis the importance of Sur­fac­tant.

“[It] is widely avail­able, es­pe­cially in pri­vate prac­tice.

“[Van Heer­den] had noth­ing to lose by us­ing the drug.

“[The baby] had a lot to lose by not re­ceiv­ing the proper treat­ment,” Smith said.

Ac­cord­ing to records be­fore court, Van Heer­den only ad­min­is­tered the life-sav­ing treat­ment af­ter the child stopped breath­ing and had no blood pres­sure when she ar­rived at the hos­pi­tal af­ter be­ing called by nurs­ing staff.

Smith  said he found it pe­cu­liar that Van Heer­den had used un­usual ven­ti­la­tor set­tings on the baby af­ter she was re­sus­ci­tated.

“[The ven­ti­la­tor] was blowing in more air rather than al­low­ing the lungs time to re­lease the air lead­ing to ir trap­ping,” Smith said.

“There was too lit­tle time for the lungs to re­lease air.”

Smith said there was ex­ten­sive evidence that the role played by the Con­tin­ued Pos­i­tive Air Pres­sure (CPAP) and the re­sus­ci­ta­tion ef­forts had been con­tribut­ing fac­tors lead­ing up to the child’s col­lapse, which could have been avoided if Sur­fac­tant was ad­min­is­tered timeously.

The par­ents of the lit­tle girl, now 10, who are not be­ing named as per a court order, are su­ing Van Heer­den and Net­care Greenacres Hos­pi­tal for R23m claim­ing neg­li­gence on be­half of both par­ties led to their daugh­ter be­ing se­verely disabled and brain-dam­aged.

Both Van Heer­den, who now lives in Namibia, and Greenacres Hos­pi­tal have de­nied neg­li­gence on their part.

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